Application for Membership

Application for Membership

We encourage prospective members to fill out this form ASAP. There is no cost for the application and we give preference to new members that have gotten us their applications sooner over those who have delayed in instances where multiple applicants share a profession.
Will this be an individual or company membership?*

IndividualCompanyUnknown (needs to be finalized before membership can be approved)
Lakes Area Referrals requires a PRIMARY MEMBER TO ATTEND the group. They will also be listed in membership documents and marketing. This individual is required even for Company memberships.

Furthermore, if you are filling out this application on behalf of someone else, we need to know that.
Are you filling this application out for yourself as the primary member to attend or someone else?*

SelfOther (Name listed below)Unknown (needs to be finalized before membership can be approved)
Applicant Name (or Name of Primary Member to Attend) - NOT business name*

First NameLast Name
Personal Address (Company Address if Company Membership)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Email*
example@example.com
Personal Phone Number*
Please enter a valid phone number.
Category Applied For (Services Provided)*

Employment/Experience
Current Employment / Business*
Business Email*
Business Phone Number*
Please enter a valid phone number.
Business Website
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Employer/Business Dates Employed (MM/YY - Present)*
Previous Employment
Required if less than 3 years in current job
Previous Employment Email
example@example.com
Previous Employment Phone Number
Please enter a valid phone number.
Previous Employment Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employment Dates Employed (MM/YY - MM/YY)

Professional References
Reference #1 Name*

First NameLast Name
Reference #1 Relationship*
How do they know you? How can they speak to your professional services and quality?
Reference #1 Phone Number*
Please enter a valid phone number.
Reference #1 Email*
example@example.com
Reference #2 Name*

First NameLast Name
Reference #2 Relationship*
How do they know you? How can they speak to your professional services and quality?
Reference #2 Phone Number*
Please enter a valid phone number.
Reference #2 Email*
example@example.com

Military/First Responder Service

Optional
Military Branch
Highest title achieved
Dates served (MM/YY - MM/YY)

Community Service & Involvement

Optional
Tell us about your community service & involvement

Disclaimer & Submission
Applicant understands that this in an Equal Opportunity Organization committed to excellence and professional opportunities.

Lakes Area Referrals is an organization that is committed to “one member” per business category. Membership in Lakes Area Referrals is solely based upon the chapter approval committee.

*Special Note: Lakes Area Referral is dedicated to each member’s success and prosperity. We reserve the right to limit each business to one direct referral group. Exclusion is observed for service, community, civic, and associated groups.

Please complete each section EVEN IF you decide to attach a resume.
I, the Applicant, certify that my answers are true and honest to the best of my knowledge, whether about myself or if filled out on behalf of another individual and/or company. I further confirm that I have the explicit permission to fill out this application on behalf of the individual listed as the "PRIMARY MEMBER TO ATTEND" (and Company, if this is for a Company membership). If this application leads to an eventual membership, I understand that any false or misleading information in the application or interview may result in the respective membership being terminated.*

YesNo
Lakes Area Referrals Core Values
- I will unite professionals for quality referrals and prioritize my own attendance or will provide a substitute.
- I will provide quality service, competitive pricing, and unwavering integrity, especially as it pertains to referrals from our group.
- I understand that members come first and that I need to prioritize internal referrals over external contacts whenever possible.
- I prioritize quality of membership in the group over the quantity of the group’s membership and will help foster a supportive environment.
- I will work to build our community of trust and mutual support, empowering professional success in the Lakes Area
- Our cost structure is fair and transparent, ensuring mutual benefit.
- I understand that I may be voted out of Lakes Area Referrals if I do not uphold these values and that it is my responsibility to ask for help and communicate with the group if I am missing the mark.
I agree to adhere to the group's current and ongoing Core Values. I Understand that the Core Values may change at the Group's discretion and I will still be obligated to these core values.*

YesNo
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Application for Membership

Employment/Experience

Professional References

Military/First Responder Service

Community Service & Involvement

Disclaimer & Submission

Lakes Area Referrals Core Values